Background and objective Previous studies suggest that error augmentation may be used as a strategy to achieve longer-term changes in gait deficits after stroke. The purpose of this study was to determine whether longer-term improvements in step length asymmetry could be achieved with repeated split-belt treadmill walking practice using an error augmentation strategy. Methods 13 persons with chronic stroke (>6 months) participated in testing: (1) prior to 12 sessions of split-belt treadmill training, (2) after the training, and (3) in follow-up testing at 1 and 3 months. Step length asymmetry was the target of training, so belt speeds were set to augment step length asymmetry such that aftereffects resulted in reduced step length asymmetry during overground walking practice. Each individual was classified as a “responder” or “nonresponder” based on whether their reduction in step length asymmetry exceeded day-to-day variability. Results For the group and for the responders (7 individuals), step length asymmetry improved from baseline to posttesting (P < .05) through an increased step length on both legs but a relatively larger change on the shorter step side (P < .05). Other parameters that were not targeted (eg, stance time asymmetry) did not change over the intervention. Conclusions This study demonstrates that short-term adaptations can be capitalized on through repetitive practice and can lead to longer-term improvements in gait deficits poststroke. The error augmentation strategy, which promotes stride-by-stride adjustment to reduce asymmetry and results in improved asymmetry during overground walking practice, appears to be critical for obtaining the improvements observed.

Background/Purpose Even after rehabilitation, many individuals with stroke have residual gait deviations and limitations in functional walking. Applying the principles of motor adaptation through a split-belt treadmill walking paradigm can lead to short-term improvements in step length asymmetry after stroke. The focus of this case study was to determine whether it is possible to capitalize on these improvements for long-term gain. Case Description The participant was a 36-year-old female who was 1.6 years post-stroke. She had a slow walking speed and multiple specific gait deviations, including step length asymmetry. Intervention The participant walked on the split-belt treadmill 3 days/week for four weeks, with the paretic leg on slow belt. The goal was 30 minutes of split-belt treadmill walking each day, followed by overground walking practice to reinforce improvements in step length symmetry. Outcome With training, step length asymmetry decreased from 21% to 9%, and decreased further to 7% asymmetry 1 month after training. Self-selected walking speed increased from 0.71 m/s to 0.81 m/s after training and 0.86 m/s 1 month later. Percent recovery, measured by the Stroke Impact Scale, increased from 40% to 50% post-training and to 60% 1 month later. Discussion Improvements in step length symmetry were observed following training and these improvements were maintained 1 month later. Concomitant changes in clinical measures were also observed, although these were relatively modest. The outcomes for this participant are encouraging given the relatively small dose of training. They suggest that short-term adaptation can be capitalized on through repetitive practice and can lead to longer-term improvements after stroke.